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Research Article | Volume 15 Issue 1 (Jan - Feb, 2025) | Pages 224 - 231
Study of Clinico-Etiological Factors of Respiratory Distress in Neonates and Its Immediate Outcome In NICU.
 ,
 ,
1
PG Resident, Department of Pediatrics Pt. JNM Medical College & B.R.A.M. Hospital, Raipur (C.G.)
2
Assistant Professor, Department of Pediatrics Pt. JNM Medical College & B.R.A.M. Hospital, Raipur (C.G.)
3
Associate Professor Department of Pediatrics Pt. JNM Medical College & B.R.A.M. Hospital, Raipur (C.G.)
Under a Creative Commons license
Open Access
Received
Nov. 23, 2024
Revised
Dec. 5, 2024
Accepted
Dec. 30, 2024
Published
Jan. 17, 2025
Abstract

Background- Respiratory Distress is one of the commonest causes of NICU admissions. Certain risk factors increase the likelihood of neonatal respiratory disease. If not recognized and managed quickly, respiratory distress can escalate to respiratory failure and cardiopulmonary arrest. Aims- To study the clinico-etiological factors of respiratory distress in neonates admitted in NICU and its immediate outcome. Methods and materials- This is a prospective study done in NICU, Department of Pediatrics, Dr. B.R.A.M hospital, Raipur from Feb 2023 to Feb 2024 in 182 patients. Both in-born and out-born neonate admitted in NICU with respiratory distress within 72 hrs of birth. Neonates with all the information (neonate & maternal information) contained in proforma will be included. Newborn babies admitted in NICU of Dr B.R.A.M. Hospital, Raipur with Respiratory Distress, during a period of 12 months, will be assessed using standard scores such as DOWNE score for term neonates and Silverman Anderson score in preterm neonates and appropriate treatment according to the scoring will be provided to the concerned neonates. Results- In present study among neonates with respiratory distress majority 57.14% were male and 42.86% were females. Mean gestational age of was 34.71±3.72 weeks. Mean birth weight of was 1925.91±649.82 gms. Majority 49.45% were of parity-2, followed by 35.16% were of parity-1, 11.54% were of parity-3 and 2.75% were of parity-4. 26% of the had MSAF, 21% of the mother had PROM and 20% of the mother had prolong labor. Comorbid illness among mothers of showed that 19.23% had anemia, 8.24% had GDM, 4.40% had hypothyroidism, 3.85% had pre-eclampsia, 2.75% had eclampsia, 2.20% had GTHN, 1.10% had sickle cell anemia and 0.55% had APH. Majority 60% of the delivery were NVD and 40% were LSCS. The Silverman Anderson Score among preterm showed that majority 13.26% had SAS-7, followed by 8.29% each had SAS-5 and SAS-6. DOWNE Score among preterm showed that majority 13.74% had score-4, followed by 11.54% had score-3. In present study Blood culture sensitivity among showed that growth was seen in only 14% cases. Conclusion- In this study we concluded that males are more affected. Child from second parity of mother is more common affected and most common, and Meconium-stained amniotic fluid was present in most patients. Anemia and GDM is most common associated co-morbidity. Most of the patients have SAS Score 7 and DOWNE’S score-4 found. Proper antenatal care, early diagnosis of the antenatal complication and avoiding preterm deliveries will aid in the better outcome of the newborns. Early detection and appropriate management of the condition is essential to ensure better outcome in all newborns presenting with respiratory distress.

Keywords
INTRODUCTION

Respiratory distress is among the most common symptom complexes seen in newborn infants and accounts for half of all the neonatal deaths.[1] Worldwide, among the Total newborns, about 3% have had some sort of respiratory distress and which is manifested by a variety of respiratory and non-respiratory disorders. [2] In developed countries, improved diagnosis and treatment due to technical advancements and increased pediatric and neonatal specializations have led to an impressive fall in neonatal mortality.

 

Respiratory Distress is one of the commonest causes of NICU admissions. Certain risk factors increase the likelihood of neonatal respiratory disease. These factors include prematurity, meconium-stained amniotic fluid (MSAF), caesarean section delivery, gestational diabetes, maternal chorioamnionitis, or prenatal ultrasonographic findings, such as oligohydramnios or structural lung abnormalities. Regardless of the cause, if not recognized and managed quickly, respiratory distress can escalate to respiratory failure and cardiopulmonary arrest. Clinical presentation of respiratory distress in newborn includes one or more of the following features respiratory rates of ≥60/ min, apnea, retractions (sub costal, inter costal, xiphoid, suprasternal), grunting, nasal flaring, cyanosis. It occurs in 5-10% of live births and is responsible for about 20% of neonatal mortality. [3,4]

 

A variety of disorders of respiratory system like Transient tachypnea of the newborn, Hyaline membrane disease, Meconium aspiration syndrome, Pneumonia, Septicemia, Persistent pulmonary hypertension and non-respiratory disorders like Cardiac, Neurological, Infectious, Metabolic disorders and Congenital anomalies can cause respiratory distress. [5,6] Commonest cause of respiratory distress in term babies is Transient tachypnea of new born whereas in preterm babies it is Hyaline membrane disease. [7,8] Continued efforts in prevention of Premature birth, early recognition of fetal distress, identification of maternal risk factors and diagnosis of diseases in utero will further improve neonatal outcome. [9] Early recognition and appropriate therapy of neonatal respiratory disease has impressive results. Though treatment is disease specific, common modalities of treatment include Resuscitation, Oxygenation, Surfactant replacement, Ventilation. Introduction of Continuous Positive Airway Pressure and Ventilators have revolutionized the outcome of respiratory failure in neonates [10]

 

Therefore, the present study conducted to study the clinical profile of respiratory distress in neonates and evaluate its immediate outcome.

 

Aims- To study the clinico-etiological factors of respiratory distress in neonates admitted in NICU and its immediate outcome.

MATERIALS AND METHODS

This is a prospective study done in NICU, Department of Pediatrics, Dr. B.R.A.M hospital, Raipur from Feb 2023 to Feb 2024 in 182 patients. Both in-born and out-born neonate admitted in NICU with respiratory distress within 72 hrs of birth and Neonates with all the information (neonate & maternal information) contained in proforma will be included. Age at admission >7 days are excluded.

 

Methodology- Newborn babies admitted in NICU, will be assessed using standard scores such as Downes score for term neonates and Silverman Anderson score in preterm neonates and appropriate treatment according to the scoring will be provided to the concerned neonates. These admissions will consist of neonates delivered in our hospital (in-born) as well as those neonates who were referred from other hospitals and other delivery centres (out-borns). Severity of respiratory distress is assessed by downe’s score (term neonates) and Silverm Ananderson score (preterm neonates).

 

DOWNE’S SCORE:

SILVERMAN ANDERSON SCORE:

In a proforma following information taken: name, age at admission, sex, date of admission and date of discharge or death. Neonatal data includes: body weight, gestational age according to the date of last menstrual period of the mother antenatal ultrasound or New Ballards score. Factors related to labor and delivery assessed includes: Mode of delivery (vaginal or LSCS or assisted), place of delivery (Inborn or Out-born), complications (prolonged rupture of membranes >18 hrs, prolonged labor>18hrs, meconium staining of liquor, antepartum hemorrhage and others).

 

Maternal information recorded includes: age (high risk group≤18 yr or ≥35 yr and low risk group 19-34 yr), parity (which is divided into risk group=P0 or ˃P4 and normal group = P1-4), any medical disease complicating pregnancy. This information is reviewed and the final diagnosis of clinical conditions producing respiratory distress is based mainly on careful scrutiny of the history, clinical and radiological findings.

 

Chest X ray is done in all cases. Complete blood counts, CRP, Blood-Culture and Sensitivity and Echo in relevant cases.

RESULTS

This is a prospective study done in NICU, Department of Pediatrics, Dr. B.R.A.M hospital, Raipur from Feb 2023 to Feb 2024 in 182 patients. Out of 182 newborns with respiratory distress, 104(57.14%) were male, 78 (42.86%) were female.

 

Table 1: Gestational age of

Gestational age

Freq. (%)

22-26 week

4(2%)

27-32 week

46(25%)

33-37 week

89(49%)

38-41 week

43(24%)

Total

182(100%)

 

There are 89(49%) were of 33-37 weeks of gestation followed by 27-32 weeks of gestation 46(25%) followed by 38-41 weeks of gestation 43(24%) and lastly 22-26 weeks which is 4(2%) in frequency. Mean gestational age of was 34.71±3.72 weeks. 95(52%) were LBW (1500-1499 gms) which is the most and 11(6%) were ELBW (<1000gms) which is the least in frequency. The mean birth weight of was 1925.91±649.82 gms.

There are 80(44%) subjects required resuscitation at the time of birth whereas 104 (56%) didn’t required resuscitation at the time of birth.

 

Table 2: Maternal age among

Maternal age

Freq. (%)

                          16-18 years

3 (1.65%)

18-24 years

80 (43.96%)

25-30 years

86 (47.25%)

31-35 years

11 (6.04%)

>35 years

2 (1.1%)

Total

182 (100%)

 

The mean maternal age of was 25.19±3.59 years. Maternal age group of 25-30 years is of 86 (47.25%) in frequency which is maximum whereas >35 years of age group is 2(1.1%) which is minimum.

 

Out of 182 subjects ,90 (49.45%) was of Parity -2 which is maximum whereas both parity-5 and parity-6 were 1(0.55%) which is minimum in frequency. Meconium-stained amniotic fluid was present in 47 (26 %) and absent 135 (74%). Prolonged rupture of membranes was present in 39 deliveries (21%) and absent in 143 deliveries (79%). Prolonged labour was present in 37 deliveries (20%) and absent in 145 deliveries (80%).

 

Table 3: Comorbid illness among mothers

Comorbid illness

Freq. (%)

Anemia

35(19.23%)

GDM

15 (8.24%)

Hypothyroidism

8 (4.40%)

Pre-eclampsia

7 (3.85%)

Eclampsia

5 (2.75%)

GHTN

4 (2.20%)

Sickle cell anemia

2(1.10%)

APH

1 (0.55%)

No

105 (57.69%)

 

105 (57.69%) mothers were not having any comorbid illness whereas 35 (19.23%) mothers were having Anemia which is most common comorbid illness whereas APH was present in 1(0.55%) mother which is least common in occurrence.

 

Out of the Total 182 cases, 110 were delivered by NVD (60%) and 72 cases were delivered by LSCS (40%), with more NVD cases. 121 were inborn (66.48%), whereas 61 were out born (33.52%).

 

Table 4: Silver man Anderson Score among preterm neonates

Silverman Anderson Score

       Freq. (%)

SAS-2

1 (0.55%)

SAS-3

10 (5.52%)

SAS-4

18 (9.94%)

SAS-5

15 (8.29%)

SAS-6

15 (8.29%)

SAS-7

24 (13.26%)

SAS-8

5 (2.76%)

NA

93 (51.38%)

Total

182 (100%)

 

Out of 182 newborns 89 were pre-terms in which SAS score has been applied, most commonly patient were of SAS score 7, 24(13.26%) whereas SAS score of 2 is least common 1(0.55%). 93 were pre-terms in which Downe’s score has been applied, most commonly patient were of Downes-6, 21(8.29%) whereas Downe’s score of 2 and 8 is least common 2(1.09%).

 

Out of 182 subjects, 102 newborns (56%) were having abnormal chest x-ray whereas 80 newborns (44%) were having normal chest x-ray.

 

Among 182 blood cultures sent, 25(13.73%) cultures came out to be positive in which most common growth is of Klebsiella pneumonia 8(4%) whereas 157 were of no growth (86.26%).

 

Table 5: Blood culture sensitivity among patients

Blood culture sensitivity

Freq.

Klebsiella pneumoniae

8 (4%)

MRSA

4 (2%)

Staph haemolyticus

4 (2%)

CONS

3 (2%)

Acinetobacter baumanii

2 (1%)

Enterobacter spp.

1 (1%)

Enterococcus spp.

1 (1%)

S. pneumoniae

1 (1%)

Staph epidermidis

1 (1%)

No growth

157 (86.26%)

Total

182 (100%)

CRP of all subjects sent, in which 34 (18.58%) came out to be positive whereas 148 (81.32%) came out to be negative.

 


In the Total 182 cases, RDS was the commonest cause of respiratory distress found in 80 cases (44%), Birth asphyxia was the second common cause found in 52 cases (29%), followed by TTN in 18 cases (10%), MAS in 15 cases (8%), Sepsis in 13(7.14%) and Pneumonia in 4 (2.2%).

 

There are 103(57%) were oxygenated by CPAP whereas 42(23%) were mechanically ventilated and 37 (20%) were provided oxygenation by nasal prongs.

 

Table 6: Stay days in hospital among

Stay in days

Freq. (%)

2-6 days

83 (45.60%)

7-11 days

42 (23.08%)

12-16 days

33 (18.13%)

17-21 days

13 (7.14%)

21-25 days

4 (2.2%)

26-30 days

2 (1.1%)

>30 days

5 (2.75%)

Total

182 (100%)

 

Out of Total 182 neonates admitted, most common duration of stay in the hospital is between 2-6 days which was 83(45.60%) in frequency whereas least common is between 26-30 days which was 2(1.10%) in frequency. Out of 182 newborns with respiratory distress 154 (85%) were discharged, whereas 28(15%) died.

DISCUSSION

The Present study conducted with the purpose to study the Clinico-etiological factors of respiratory distress in neonates admitted in NICU and its immediate outcome.  In present study among neonates with respiratory distress majority 57.14% were male and 42.86% were females. Mehta A et al (2017) study the causes of respiratory distress in neonates presenting within 72 hours. Out of 330 neonates (31.98%) admitted with features of RD. Male neonates were two third (67.88%) with M: F ratio of 2.1: 1. [13]

 

Gender distribution comparison

Study

Male

Females

Gaurav et al 2023

56.30

43.70

Sahoo R et al 2015

56.66

43.34

Present study

58.14

42.86

 

In present study mean gestational age of was 34.71±3.72 weeks. Majority 49% were b/w 33-37 weeks of GA, followed by 25% b/w 27-32 weeks, 24% were b/w 38-41 weeks and 2% were b/w 22-26 weeks. Lamichhane A et al (2019) study the clinical Profile of Neonates with Respiratory Distress in a Tertiary Care Hospital. They reported that 40.54% were term neonates (>37 weeks) and 59.46% were preterm neonates. [19]

 

Gunasekhar RS et al (2019) did a study of neonatal morbidity and mortality in government general hospital, Srikakulam Andhra Pradesh. Thery reported that the minimum and maximum gestational age of the neonates was 25 and 43 weeks respectively. Majority (58.22%) of the neonates were born at full term of gestation, preterm 34-37 weeks were (23.54%), less than 34 weeks were (18.23%). [16]

In present study the mean birth weight of was 1925.91±649.82 gms. Majority 52% were LBW, followed by 16% were VLBW, 6% were ELBW and 26% were normal.

Lamichhane A et al (2019) study the clinical Profile of Neonates with Respiratory Distress in a Tertiary Care Hospital. They reported that the mean weight of the babies was 2.25±0.63 kg. Majority 50.45% were LBW, 10.81% were ELBW and 38.74% were normal weight. Respiratory distress was common (61.26%) in the low-birth-weight babies (<2.5Kg). [22]

Chandini et al (2020) study the clinic-etiological profile and outcome of neonatal respiratory distress in tertiary care hospital, Guntur. The study showed There were (34%) babies with birth weight >2.5kg, (52%) babies with 2.5 -1.5 kg and (14%) babies with <1.5kg. [18]

In Present study, 44% required resuscitation at the time of birth whereas 104 (56%) didn’t required resuscitation at the time of birth. In present study birth parity among showed that majority 49.45% were of parity-2, followed by 35.16% were of parity-1, 11.54% were of parity-3 and 2.75% were of parity-4.

Kshirsagar VY et al (2019) study the clinical profile and outcome of respiratory distress in newborns admitted in rural tertiary health care centre of Maharashtra, India. They reported that 46% were of primi-gravida, 40% were of 2 and 3 parity and 14% were multi para. [14]

Reshmi et al (2019) study the clinico-etiological profile of respiratory distress in neonates. They reported that majority 45% were of parity-2, followed by 32% were of parity-1, 18% were of parity-3 and 5% were of parity-4. [15]

In Present study, maternal age group of 25-30 years is of 86 (47.25%) in frequency which is maximum whereas >35 years of age group is 2(1.1%) which is minimum.

In present study 26% of the had MSAF, 21% of the mother had PROM and 20% of the mothers had prolong labor. In present study comorbid illness among mothers of showed that 19.23% had anemia, 8.24% had GDM, 4.40% had hypothyroidism, 3.85% had pre- eclampsia, 2.75% had eclampsia, 2.20% had GTHN, 1.10% had sickle cell anemia and 0.55% had APH.

Barkiya SM et al (2016) study the clinico-etiological profile and outcome of neonatal respiratory distress. They reported the maternal risk factor PROM in 11%, hypertension in 5%, MASF in 5%, Maternal pyrexia in 5% and DM in 1% cases. [11]

 

Sauparna C et al (2016) did a clinical study of prevalence, spectrum of respiratory distress and immediate outcome in neonates. Thery reported that in 20.5% cases meconium aspiration syndrome was present. [12]

Mehta A et al (2017) study the causes of respiratory distress in neonates presenting within 72 hours. They reported that in 11.5% cases meconium aspiration syndrome was present. [13].

In present study majority 60% of the delivery were NVD and 40% were LSCS. Lamichhane A et al (2019) study the clinical Profile of Neonates with Respiratory Distress in a Tertiary Care Hospital. They reported that 49.95% had Normal delivery, 51.35% had LSCS birth and 2.70% had vacuum delivery. [19]

Gaurav et al (2023) study the epidemiology of neonatal respiratory distress in a tertiary care neonatal Centre Kashmir India. They reported that 69.10% had LSCS and 30.90% had NVD. [18]

 

Mode of delivery comparison

Study

LSCS %

NVD %

Gaurav et al 2023

69.10%

30.90%

Sahoo r et al 2015

56%

44%

Present study

40%

60%

 

In present study the Silverman Anderson Score among preterm showed that majority 13.26% had SAS-7, followed by 8.29% each had SAS-5 and SAS-6, 9.94% had SAS-4, 5.52% had SAS-3 and 2.76% had SAS-8.

Mehta A et al (2017) study the causes of respiratory distress in neonates presenting within 72 hours. They reported that 35.76% of the had SAS score <3, 33.64% had SAS score b/w 4-6 and 30.61% had SAS score b/w 7-10. [13]

Chandini et al (2020) study the clinic-etiological profile and outcome of neonatal respiratory distress in tertiary care hospital, Guntur. The study showed that the Anderson Silverman score of >7 was observed in 24% of preterm babies. [18]

In present study the DOWNE Score among preterm showed that majority 13.74% had score-4, followed by 11.54% had score-3, 8.24% had score 2, 6.59% had score 5,6.04% had score 6 and 4.95% had score more than 6.

Kshirsagar VY et al (2019) study the clinical profile and outcome of respiratory distress in newborns admitted in rural tertiary health care centre of Maharashtra, India. They reported that 50% had downer’s score b/w 3-7, 27% had score >7 and 23% had score <3. [14]

Chandini et al (2020) study the clinic-etiological profile and outcome of neonatal respiratory distress in tertiary care hospital, Guntur. The study showed that Downes score of > 7 was observed in 18%. Score of > 7 is mostly associated with MAS (58.3%) followed by Pneumonia (24.2%). [18]

CONCLUSION

The commonest cause for respiratory distress in neonates is RDS followed by, Birth asphyxia, TTN, MAS and sepsis. Fetal risk factors were low birth weight and preterm period of gestation. In this study we concluded that males are more affected. Child from second parity of mother is more common affected and most common, and Meconium-stained amniotic fluid was present in most patients. Anemia and GDM is most common associated co-morbidity. Most of the patients have SAS Score 7 and DOWNE’S score-4 found. Proper antenatal care, early diagnosis of the antenatal complication and avoiding preterm deliveries will aid in the better outcome of the newborns. Early detection and appropriate management of the condition is essential to ensure better outcome in all newborns presenting with respiratory distress.

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